In emergent situations when an individual in unable to breathe, airway access is the primary concern. In the circumstance where there is an inability to place a breathing tube transorally (through the mouth), a surgical airway must be performed. Surgical access can be achieved through the cricothyroid membrane (cricothyrotomy) or trachea (tracheotomy). During these procedures, an incision is made on an anterior aspect of a neck of a person below an obstruction in order to open a direct airway. The opening serves as a site for insertion of a hollow tube (i.e., tracheotomy tube) into the opening. The hollow tube may allow the person to breathe without the use of his or her nose or mouth.
In these situations, time is of the essence and ease of surgical access is paramount. Unfortunately, the current standard procedure to perform a surgical airway either through the cricothyroid membrane or trachea contains multiple steps and multiple instruments. Additionally, many of these surgical airway procedures, especially when not performed in the hospital setting, are performed at night without adequate light for visualization. This complexity leads to delays in airway access or the complete inability to gain access to the airway in time to help the patient.
The standard procedure for access to the airway generally entails making a large incision over either the cricothyroid membrane or trachea. The incision is then continued down to the airway causing unneeded trauma to the surrounding structures and excessive bleeding. An incision is then made into the airway (cricothyroid membrane or trachea). The knife is removed from the airway, turned over, and the handle placed into the airway. This causes an unnecessary loss of contact with the newly found airway. A separate hook instrument is then used to secure the airway. The handle of the knife is then removed from the airway. The hand that was previously used to hold the knife grabs an endotracheal tube. The endotracheal tube is forced into the airway. There is no way to confirm proper placement of the endotracheal tube in the airway at the time of placement. A syringe is then needed to inflate the balloon on the endotracheal tube.
Once the patient is stable, the endotracheal tube has to be replaced with a tracheotomy tube. The tracheotomy tube has an indwelling inner cannula that allows for dilation of the airway as it is inserted. Once the tube is in place, the inner cannula is removed and a second hollow inner cannula is inserted. A syringe is needed to inflate the balloon on the tracheotomy tube. The tube is then secured to the patient's airway. There are numerous problems with this procedure. These issues include, but are not limited to: (1) the need for multiple steps; (2) excess time needed to perform multiple steps; (3) a large incision causing damage to surrounding structures and excess bleeding; (4) the potential for the incision to cause damage to vital structures; (5) the potential for the incision to go completely through the airway; (6) multiple steps where the person performing the procedure is not in contact with the airway; (7) the need for multiple instruments; (8) the need to grab a syringe to inflate the balloon; (9) the need to replace an endotracheal tube with a tracheotomy tube; (10) poor lighting and visualization; and (11) no confirmation that the tube is in the airway.
A second technique is used less frequently. This is called the Seldinger technique. With this technique, an incision is made through the skin above the airway. A needle is placed into the airway. A wire is placed through the needle into the airway. The needle is removed. A dilator is placed over the guide wire to dilate the airway so the tracheotomy tube can be placed. The tracheotomy tube is then placed over the guide wire. The guide wire is then removed. This procedure is also associated with many problems including, but not limited to: (1) the need for multiple steps; (2) excess time needed to perform multiple steps; (3) a large incision causing damage to surrounding structures and excess bleeding; (4) the potential of the needle to go completely through the airway; (5) multiple steps where the person performing the procedure is not in contact with the airway; (6) the need for multiple instruments; (7) the need to grab a syringe to inflate the balloon; (8) poor lighting and visualization; (9) blunt dilation of the airway causing excess damage; and (10) no confirmation that the tube is in the airway
Therefore, it would be desirable to provide an apparatus and method that overcome the above problems.